With the NBA Finals in full swing I thought we’d take on a basketball topic for this week’s version of The 11 Blade. The orthopedic injuries basketball players encounter are many, but they are certainly not as frequent as in other contact sports. At D1 Birmingham we treat largely knee ligament injuries (such as those to the ACL), achilles ruptures, and shoulder instability in the hoops population. You can see our recommendations for sports safety in basketball here. Today, however, I will specifically discuss not a particular injury, but rather, my take on the recent controversy regarding the decision not to play Chicago Bulls guard Derrick Rose despite a playoff push (and the fact that, at the end of the day, for professional athletes, return to play is, indeed, return to work). That said, as an orthopedic sports specialist, the decision of when an athlete should return to play following recovery from an injury is one which my patients and I face every day – so it warrants some discussion.
Rose, undeniably one of the stars of the NBA, underwent anterior cruciate ligament reconstruction last year, and, as fate would have it, seemed to be closing in on completing his rehab and returning to the court just in time for the Bulls to make a playoff run. There ensued various conflicting reports as to what “percent” ready his knee was, a number of parties with various motivations became involved, and it was readily apparent that this had become far more complicated that a simple question of medical readiness. This was, rather, a soap opera drama, with the young man’s knee as the plot line.
Now, the circumstances, injury, and sport were quite different, but the question was largely the same last year when a similar issue arose in Major League Baseball. The Washington Nationals, who like the Bulls had their sites set on post-season glory, had their ace, Stephen Strasburg, hold out from participation after a specific number of innings thrown. Strasburg had previously overcome surgery and rehab from ulnar collateral ligament reconstruction (or UCL, more commonly known as the Tommy John procedure). In this circumstance, the athlete and his caregivers had the objective of preventing re-injury by limiting the patient from overuse. It is my judgement that they were absolutely right in doing this. However, they would also be absolutely right to tell him not to throw at all. Ever. Indeed the athlete’s risk of re-injury is limited with limited participation, but the patient population is too small and the data too limited to say with any certainty when the risk/benefit scales are tipped in the direction of continuing on or stopping play.
So, how do we really determine, from a medical standpoint, when a patient can return to play? I try to keep it as simple as possible. For my patients, I recommend that they may return to play when their risk for injury has returned to the baseline risk for their sport. That doesn’t always mean they can play – medical readiness and competition readiness don’t always align. It also doesn’t mean that medical concerns are the only factors to consider, as is clearly demonstrated in the cases of Strasburg and Rose – family concerns, professional club investments in the player, team dynamics and chemistry, and current team success or projected success can all play a role in this decision. So, as tough as it was for the Bulls to endure, I really side with Rose sitting out. I am reminded of a very young man I was treating for a tibia fracture sustained while playing quarterback (not too dissimilar from the famous Joe Theisman injury). After months of rehab and healing the Mom said tearfully, “Dr. Connor please tell him he can’t play football again.” I replied, “Well, his leg is healed. The sport has inherent risks. I can only say that he may play from a medical standpoint. Weather or not he can is up to you and him.”
Until next time, Stay Well.